To enhance safety culture and reduce errors in hospital units, lessons from high-risk industries can increase effectiveness of health information technology (HIT)-supported nurse care-planning and record-keeping. This three-year project supports the care planning process by standardizing and structuring the activities surrounding it, and making it transferable between nurses on one unit, between units, and among health care settings. The central hypothesis is that the reengineered HIT-supported care planning process leads to a safety culture through the development of greater "collective mind," "mindfulness," and "heedful interrelating" among nurses across time and settings by to facilitate information flow. This study addresses AHRQ Objective 5, relating to the creation and diffusion of knowledge regarding the value of HIT, and to the creation of new knowledge and evidence regarding the benefits of HIT in various health care settings. The specific aims of this project are: 1) to demonstrate that HIT can be successfully implemented to support nurses in a dynamic care planning process encompassing both the planning and provision of care within units and across healthcare settings; and 2) to demonstrate that a HIT-supported care planning process leads to a stronger safety culture. A convenience sample of eight nursing units (four units in year one, four units in year two) in five healthcare organizations will complete the care planning training and implement the Hands-on Automated Nursing Data System (HANDS) care planning process under real-time conditions to test standardization and improvement in communication and enhancement of a safety culture. Data analysis and interpretation will inform the long-range goal of a future real-time implementation in settings across the country, leading to interdisciplinary integration and informing execution of an Electronic Health Record (E.H.R.).